Section II: Prevention and Treatment

Management of Lead-Poisoned Children

Childhood Lead Poisoning Prevention Program

The State Health Department's Lead Poisoning Prevention Program, in partnership with local health departments and the health care provider community, coordinates efforts to prevent, detect, and treat children with elevated blood lead levels. The partners work together to: (1) pursue universal screening of one and two year olds, and target screening of children ages 6 months to 6 years assessed to be at high-risk for lead exposure; (2) educate the public and health professionals about prevention, early detection, and treatment; (3) provide case management for children with elevated blood lead levels, including environmental assessment and lead hazard control; (4) ensure that families of children with lead poisoning are given advice and technical assistance in locating sources of lead in the child's environment; (5) provide assistance to pediatric care providers about medical management of children with EBL through the establishment of regional lead poisoning prevention resource centers, and (6) provide lead-safe interim housing for families of children being treated for EBL of 20ug/dL or greater while the lead hazards in their environments are addressed.

Environmental Management

The environmental assessment and lead hazard control components of case management are conducted by environmental health personnel in 36 local health departments, the New York City Department of Health, and the Department's nine district offices (which cover 21 upstate counties). Environmental management is provided for children with EBL of 20ug/dL or higher in order to identify and eliminate sources of lead exposure. By law, the property owner is required to correct hazardous lead conditions when a child under age six is identified as having an EBL of 20 ug/dL or higher.

An environmental assessment includes evaluation of all dwellings (home, child care facility, etc.) where the lead-poisoned child spends more than 8 hours per week. The presence of lead hazards may be verified through on-site testing including use of an X-ray fluorescence lead-in-paint analyzer (XRF), and/or laboratory analysis of paint dust/chips or other material samples. After testing, officials prepare a detailed assessment report, and a notice and demand for corrective action. These documents include sample locations, sample results, and dwelling diagrams to assist the property owner in correcting the identified hazards. When an owner of a dwelling fails to comply with the written notice and demand, Public Health Law outlines procedures for enforcement.

County Environmental Management Activity

Tables 8 and 9 illustrate environmental case management activities for years 2000 and 2001, respectively. Similar to the trends in elevated blood lead levels, the number of required assessments has also declined. Though environmental assessment is required only when a child's blood lead level is above 20 ug/dL, 77% of local health departments also offer environmental assessment and intervention services to the families of children with blood lead found to be in the range of 15 to 19 ug/dL.

New York State's Effort for the Future

Although the number and proportion of children newly identified with elevated blood lead levels continues to decline, meeting the national goal of eliminating elevated blood lead levels (>10ug/dL) in children by 2010 remains a significant challenge. The age and condition of the housing stock combined with the number of children living in poverty are important factors that influence the pervasiveness and persistence of childhood lead poisoning.

To successfully meet this challenge, the State Health Department will continue its emphasis on universal screening at one and two years of age as well as stress the importance of re-screening if an initial blood lead screening test is not elevated. Focused efforts will be applied to reaching young children in low-income areas that have a large percentage of homes constructed prior to 1950. In addition, the Department will assist primary care providers in implementing universal screening, including provider education. Continued support will be offered to local health departments to target educational and environmental interventions to neighborhoods identified as having a high rate of children with EBL. The Department will also work to identify barriers to having children screened for EBL, as well as increasing the number of "lead-safe" homes through preventive environmental interventions.

To assure that children receive timely and effective case management the Department is developing a model of "best" practice for case management of children identified with elevated blood lead levels.

Acknowledgements

Resources from the Centers for Disease Control and Prevention and the Maternal Child Health and Preventive Health Services Block Grants (MCHSBG) were utilized to prepare this report.

For copies of this report and/or more information about the Childhood Lead Poisoning Prevention Program of the New York State Department of Health